超声检查早期诊断体外受精-胚胎移植术后复合妊娠

目的探讨超声检查早期诊断体外受精-胚胎移植术(IVF-ET)后复合妊娠(HP)的价值。方法回顾性分析81例IVF-ET后临床确诊为复合妊娠患者的超声和手术情况,并随访宫内妊娠结局。结果超声诊断HP的时间为IVFET后20~49天,平均(29.08±5.74)天。81例中,术前超声诊断为宫内合并输卵管妊娠70例,宫内合并宫角妊娠8例,宫内合并宫颈妊娠、宫内合并肌壁间妊娠、单侧输卵管妊娠各1例;术前超声误诊3例,漏诊1例;超声诊断符合率为95.06%(77/81)。对77例宫内妊娠情况进行随访,其中60例已分娩或继续妊娠,6例术后宫内胚胎停育而接受清宫术,1例因21-三体高风险而接受引产,10例失访。结论超声检查可早期诊断IVF-ET后HP,指导临床及时治疗。     

Heterotopic pregnancy presenting as an acute abdomen: a diagnostic masquerader

Simultaneous intrauterine and extrauterine pregnancy is called heterotopic pregnancy. It is a rare complication of pregnancy, especially in the absence of predisposing factors. It is known to present with a variety of symptoms and signs often leading to a delay in establishing the correct diagnosis. We report the case of a 29-year-old woman, known to be 14 weeks pregnant, presenting with acute abdominal pain. The confirmation of a viable intrauterine pregnancy led to a general surgery consultation. A heterotopic ruptured right ectopic tubal pregnancy was found. Right salpingectomy was performed. The patient recovered uneventfully. The intrauterine pregnancy was not affected. This case illustrates the variable presentation of heterotopic pregnancy and the need for general surgeons to be suspicious of pregnancy related complications, even in the presence of a viable intrauterine pregnancy.     

Tubal abortion masquerading as an acute appendicitis with a negative urine pregnancy test: A case report

Introduction and importanceSpontaneous expulsion of product of conception through the fimbrial end to the peritoneal cavity is a rare mode of progression of tubal pregnancy. Thus, ectopic pregnancy can present with right-sided iliac fossa pain which can be preoperatively misdiagnosed as acute appendicitis.Case historyA 30-year regularly menstruating woman presented with right iliac fossa pain which was diagnosed as acute appendicitis preoperatively with an ultrasound. However, intraoperatively, a product of conception-like material measuring 3 1 3 cm was seen hanging from the right fimbrial end of the fallopian tube with a normal appendix. With an intraoperative diagnosis of spontaneous tubal abortion, histopathology of the resected mass showed chorionic villi lined by trophoblastic cells along with decidualized tissue, fibrinoid material, and blood clot.DiscussionEctopic pregnancy presenting as a right iliac fossa pain can mimic acute appendicitis. An abnormal β-hCG pattern/level which doesn't correspond to the gestational age suggests the likely diagnosis of ectopic gestation. Transvaginal ultrasound is the preferred imaging modality for the evaluation of patients with suspected ectopic gestation. A urine pregnancy kit cannot always exclude an underlying ectopic pregnancy because of the associated false-negative results.ConclusionUrgent laparotomy to prevent detrimental complications associated with ectopic gestation should be done. Surgeons should be aware of this suspicion as a false negative UPT can happen and misguide clinicians about the possible occurrence of ectopic pregnancy.     

输卵管妊娠腹腔镜下输卵管切除术与输卵管切开取胚术应用比较

目的比较腹腔镜下输卵管切除术和输卵管切开取胚术治疗输卵管妊娠术后患者不同的生育结局。方法回顾性分析腹腔镜下双侧输卵管无明显粘连的55例接受输卵管切开取胚术和50例接受输卵管切除术的输卵管妊娠患者,比较两种术式患者术后再次获得宫内妊娠、术后持续性异位妊娠、重复异位妊娠的差异。结果腹腔镜下输卵管切开取胚术后组患者宫内妊娠(38/55,69.09%)发生率明显高于输卵管切除术组(25/50,50.00%),差异有统计学意义(P0.05),两组患者术后持续性异位妊娠和重复异位妊娠的发生率差异无统计学意义(P均0.05)。结论对于双侧输卵管外观无病变、且有生育要求的输卵管妊娠患者,应选择行腹腔镜下输卵管切开取胚术,对于患者术后生育力更为有利。     

剖宫产瘢痕妊娠：MRI与经阴道超声对照

目的评价MRI及经阴道超声诊断剖宫产瘢痕妊娠（CSP）的价值。方法回顾性分析经手术证实的28例CSP患者的MRI、经阴道超声表现,对比两种方法显示孕囊位置、大小、性质、对子宫肌层的浸润、是否合并囊内及宫腔出血、对卵黄囊显示及存活状况等情况。结果MRI及经阴道超声均可显示23例囊性孕囊和5例包块型孕囊。23例囊性孕囊中,MRI诊断孕囊内合并出血6例,经阴道超声发现囊内出血2例;MRI无法显示卵黄囊及判断胚胎是否存活;经阴道超声发现卵黄囊12例,其中胚胎存活10例。MRI显示孕囊位于瘢痕周围肌层内9例,位于瘢痕处向官腔方向延伸14例,经阴道超声诊断位于肌层8例,瘢痕及官腔内15例。5例包块型孕囊中,MRI均见包块内出血,经阴道超声诊断包块内出血3例;MRI诊断包块对子宫肌层浸润5例,经阴道超声无法判断孕囊对子宫肌层的浸润。MRI诊断官腔内积血18例,经阴道超声诊断8例。结论联合应用阴道超声与MRI有利于诊断CSP。     

Association d’un kyste arachnoïdien et d’une hétérotopie de tissu glial dans le méat auditif interne

ObjectivesWe report a case of an association of an arachnoid cyst with heterotopic neuroglial tissue in the internal auditory canal.Material and methodsA 66-year-old woman consulted for cochleovestibular syndrome.ResultsMRI demonstrated a lesion with spontaneous hypersignal on T1- and T2-weighted images, instigating surgical exploration. We discovered a hematic arachnoid cyst associated with heterotopic neuroglial tissue arising in the internal auditory canal.ConclusionAn arachnoid cyst arising within the cerebellopontine angle or the internal auditory canal is a rare occurrence. Clinical manifestations are identical with those produced by a cochleovestibular schwannoma. MRI usually demonstrates a nonenhancing isointense cystic mass with cerebrospinal fluid on all sequences (hypointense on T1-weighted and hyperintense on T2-weighted images). These lesions are usually monitored. Spontaneous hypersignal on T1- and T2-weighted images makes diagnosis difficult, as in our case, leading to surgical exploration.     

Abdominal pregnancy diagnosed by ultrasonography and treated successfully by laparotomy: Two cases report

IntroductionAbdominal pregnancy is one of the rare types of ectopic pregnancies that has a high rate of mortality. Its clinical presentation is similar to those of the other types of ectopic pregnancies.Cases presentationwe report two cases of abdominal pregnancies whose the diagnosis was made by ultra-sonography and successfully treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca.Clinical discussionthe ultra-sonography based on precise criteria represents the fundamental paraclinical examination in the diagnosis of abdominal pregnancies. The treatment of early form is based on surgery; And despite the advent of laparoscopic surgery, laparotomy retains its indications including forms with hemorrhagic shock.ConclusionDue to the high risk of complications and maternal mortality, abdominal pregnancies should be surgically treated as soon as possible when the diagnosis is confirmed.     

IVF-ET术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局分析

目的 分析体外受精-胚胎移植(1VF-ET)术后宫内妊娠合并输卵管妊娠的诊治及妊娠结局.方法 回顾性分析2014年3月至2019年6月于我院诊治的IVF-ET周期宫内妊娠合并输卵管妊娠患者50例的临床资料.分析其临床特征、超声表现、治疗方式及妊娠结局等.结果 (1)本研究50例患者中10例(20.0％)无明显症状,16...     

Unusual gestational choriocarcinoma arising in an interstitial pregnancy

INTRODUCTION

Choriocarcinoma is a highly malignant trophoblastic neoplasm. Its association with ectopic pregnancy is very rare and usually with aggressive behavior.

PRESENTATION OF CASE

We report a new case arising in an interstitial pregnancy occurring in a 46-year-old woman. The patient was admitted for severe pelvic pain and abundant metrorrhagia. One month ago, she had had a laparoscopic resection of an interstitial pregnancy subsequent to failure of chemotherapy by methotrexate. The raise of serum βhCG level and the hyperechoic intrauterine mass were in favor of gestational trophoblastic disease. Urgent laparotomy was performed for circulatory collapse. Hysterectomy was done. Histological examination revealed a choriocarcinoma. The patient underwent chemotherapy. Two years later, neither metastasis nor recurrence was detected.

DISCUSSION

Clinical diagnosis of primary interstitial choriocarcinoma is difficult, since it is rare and manifesting by non-specific abnormal vaginal bleeding. Imaging findings are also not helpful in ectopic location. The frequency of metastasis is related to the delayed diagnosis. Serial measurement of βhCG level was the most useful marker of diagnosis and follow up. Histopathological examination remains the only tool of the precise diagnosis. Choriocarcinoma has a very good prognosis even in advanced stages, since it is very chemosensitive.

CONCLUSION

The current trend of the treatment of ectopic pregnancy by conservative surgery requires adequate monitoring of βhCG and careful examination of pathologic specimens to avoid misdiagnosis of ectopic gestational trophoblastic disease.     

First recorded spontaneous quintuplets born in Somalia: A case report

Introduction and importanceQuintuplets conceived spontaneously are a rare occurrence. As compared with singleton pregnancies, quintuplets are associated with high rates of obstetric complications and significant prenatal morbidity and mortality. To our knowledge, here we reported the first case of spontaneous quintuplet pregnancy faced by a practicing clinician in an underdeveloped country (Somalia) with a Successful outcome.Case presentationA 32-year-old woman presented in her third trimester of gestation at 30 weeks feeling pain and uterine contractions.Clinical findings and investigationsUltrasound examination showed multiple pregnancies with four alive intrauterine pregnancies, but quintuplets could not be ruled out. Fetal heart activities were present, and the amniotic fluid was normal in amount.Interventions and outcomeExtensive preparations made included four sets of ventilators. We did an emergency cesarean section under spinal anesthesia: five alive infants, three boys and two girls delivered in cephalic and breech presentations.ConclusionsQuintuplet pregnancy is rare but poses relevant clinical problems to both the obstetrician and the neonatologist.Relevance and impactThe takeaway lesson from this case would be that Pregnancy with multiples is considered a high-risk pregnancy; with more complications observed as the number of fetuses increases, their effective follow-up requires early diagnosis with regular monitoring.Through this case, we would like to highlight the urgent need to focus on the delivery of women's health care services in Somalia, along with the need to recognize the importance of receiving antenatal care in the community so that the burden of thousands of lives that are lost each year could be reduced. This case report has been reported according to the SCARE Criteria (Agha et al., 2020).     

Spontaneous bilateral tubal pregnancy

With the increase in incidence of ectopic pregnancy over the decades, bilateral ectopic pregnancy is also increasing. It is usually associated with assisted reproductive techniques (ART) but in recent years few cases of spontaneous bilateral ectopic pregnancy have been reported. Gynaecologists should be aware of this and that ultrasonography has limitations in diagnosis. In cases of ectopic pregnancy where contralateral adnexa is not clearly identified on ultrasound and fertility needs to be conserved, patient should be managed by experts in well equipped centres. A case of spontaneous bilateral tubal pregnancy that remained undiagnosed till laparotomy, is described.     

Multidisciplinary approach to breast cancer diagnosed during pregnancy: Maternal and neonatal outcomes

AimWe assessed maternal and neonatal outcome in women diagnosed with breast cancer during pregnancy.Patients and methodsRetrospective single-centre cohort study of 25 consecutive pregnant women (mean age 36 years) diagnosed and treated for breast cancer between 2000 and 2011. Management was individualized according to type of tumor and time of gestation at diagnosis.ResultsTwelve patients were diagnosed during the second trimester. BI-RADS category <3 mammographic lesions were diagnosed in 7 patients. A suspicious area was detected by ultrasound in 20 of 21 women who underwent ultrasound studies. Nineteen patients had positive hormone receptors and 7 sobreexpressed HER2. One patient was in stage 0, 8 in stage I, 8 in stage II, 3 in stage III and 5 in stage IV. Four patients decided voluntarily to legally terminate their pregnancies, one had a spontaneous miscarriage and in three patients, pregnancy was interrupted at the end of the third trimester before oncological treatment. Eleven patients were treated with chemotherapy during pregnancy after the second trimester using anthracycline-based regimens. In five patients the pregnancy was ended before 34 weeks of gestation. Nine patients had gestation-related complications, including preterm labor, pneumonia, increase in velocity of the middle cerebral artery, oligohydramnios, preeclampsia, extreme prematurity, intrauterine growth restriction, dyspnea, spontaneous miscarriage and chemotherapy-related granulocytopenia. Betamethasone to stimulate fetal lung maturation was used in 6 patients.ConclusionBreast cancer women diagnosed during pregnancy presented a high number of complications unrelated to antineoplastic treatment. A multidisciplinary team approach is necessary for satisfactory neonatal results.     

Jejunal varices with extra hepatic portal vein obstruction: A case report

Introduction and importanceExtrahepatic portal vein obstruction (EHPVO) with portal hypertension is rare in children. Intestinal varices as new collaterals accompanying portal hypertension are very rare.Presentation of caseWe report an unusual case of a 12-year-old boy with EHPVO with gastrointestinal bleeding from ectopic jejunal varices, without any gastroesophageal varices.DiscussionPortal hypertension is the most common cause of EHPVO. Among various ectopic varices, intestinal varices are found distal to the duodenum and present with complaints of hematochezia, melena, or intraperitoneal bleeding. The diagnosis of the EHPVO is aided by imaging investigations like Doppler ultrasound, computed tomography, or magnetic resonance imaging. A multidisciplinary team including gastroenterologists, interventional radiologists, surgeons, and intensivists is crucial in the management of ectopic varices.ConclusionJejunal varices must be considered in the differential diagnosis of gastrointestinal (GI) hemorrhage in patients with a negative source of bleed on upper and lower GI endoscopy.     

Heterotopic ossification within the gallbladder – First reported Australian case

IntroductionWe report the rare and unusual case of heterotopic ossification within the gallbladder secondary to chronic calculi debris. Presentation of case. A 35-year-old female underwent routine laparoscopic cholecystectomy for recurrent intermittent right upper quadrant pain which had persisted for three months and was worse post prandial with associated nausea. Abdominal ultrasound prior to surgery was reported by a consultant radiologist as demonstrating a thin-walled gallbladder and cholelithiasis, without features of cholecystitis. At four-week review, she had recovered well with no concerns. The histopathology report revealed fibromuscular hyperplasia and patchy chronic inflammation. Rokitansky-Aschoff sinuses were present and cholesterosis was noted. Additionally, there was a focus of eroded mucosa showing adherent microlithiasis with an incidental focus of heterotopic ossification within the mucosa, there was no evidence of dysplasia or malignancy.DiscussionGallbladder heterotopic ossification is exceedingly rare, with few cases reported. To our knowledge this is the first reported case in Australia.ConclusionIn conclusion, we report the rare and unusual finding of heterotopic ossification of the gallbladder, and suspect that inflammation secondary to calculous debris initiated the ossification. Current technical limitations preclude diagnosis prior to surgery. Appropriate follow-up is unclear, but we feel a single report associated the finding with adenocarcinoma was sufficient to warrant follow-up.     

Spontaneous cranial bone regeneration following craniectomy for traumatic brain injury in a pregnant woman: A case report

Introduction and importanceSpontaneous bone formation following craniectomy is an extremely rare in adult. As in the medical literature, this is the first case report on total spontaneous ossification following craniectomy in a pregnant woman.Case presentationIn this paper, we reported a 20-year-old female currently in the 30th week of her pregnancy suffered from head trauma following motorcycle accident. On admission to our hospital, her GCS score was 3 points. She was treated with emergency extradural hematoma evacuation with craniectomy and Caesarean section with uterine artery ligation. 3 weeks post-operation, the patient and her daughter were discharged from the hospital. At follow-up, spontaneous cranial bone generation was observed.Clinical discussionThe presentation, diagnosis and strategy of treatments were discussed.ConclusionDiagnostic imaging in traumatic pregnant patient is often postponed for the concern of fetus exposure to radiation. Traumatic pregnant patient with possible head trauma should be transferred to a center with expertise in neurotrauma and obstetrical care. Spontaneous cranial bone regeneration following craniectomy in adult is rare. Surgery techniques and hormones in pregnancy contribute to bone formation.     

体外受精-胚胎移植术后宫内宫外同时妊娠15例临床分析

目的探讨体外受精-胚胎移植(IVF-ET)后宫内宫外同时妊娠的发病率、危险因素、早期诊断及最佳治疗方式。方法对2001年10月至2006年10月在我院生殖中心行IVF-ET后获宫内宫外同时妊娠(HP)15例进行回顾性分析。结果同期IVF-ET后临床妊娠1,230例,HP15例,发生率1.2%。15例均为输卵管因素不育,其中1例合并男性因素;7例有盆腔手术史,3例宫外孕史;14例为宫内合并输卵管妊娠,1例为双侧输卵管切除术后合并间质部妊娠。15例患者均于确诊后手术治疗,其中10例在异位妊娠破裂前确诊,5例于破裂后确诊。术后9例宫内妊娠继续至足月分娩,4例胚胎停止发育,2例继续妊娠。结论输卵管病变或(和)盆腔手术史是IVF-ET术后HP发生的主要危险因素。IVF术前术中适当处理、早期诊断、及时治疗异位妊娠,有助于挽救宫内妊娠。     

Spontaneous uterine rupture during the first trimester of a partial molar pregnancy in a scar uterus: A rare case report

IntroductionSpontaneous uterine rupture in the first trimester is a redoubtable obstetric emergency that carries a high risk for both mother and fetus.Cases presentationWe present the case of a spontaneous uterine rupture in a patient with a scarred uterus at 9 weeks' gestation treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca; whose histological examination of the removed material found a partial mole.Clinical discussionSpontaneous uterine rupture in the first trimester is rare and usually occurs in a scarred or malformed uterus. Clinicians should consider this diagnosis in the presence of an acute abdominal pain in early pregnancy with or without first trimester metrorrhagia.ConclusionSince the rate of uterine surgeries is increasing, it is necessary to highlight the risk of uterine rupture occurring early in order to improve their management. Molar pregnancy is a factor of fragility of the uterine wall and uterine rupture must be suspected in any molar pregnancy associated with a hemoperitoneum.     

腹腔镜在异位妊娠诊治中的价值

目的 探讨腹腔镜手术在异位妊娠诊断和治疗中的价值。方法 2003年1月～2005年1月,我院对342例临床拟诊异位妊娠行腹腔镜检查。诊断明确335例,行单侧输卵管切除术、输卵管开窗术、部分卵巢切除术或宫角切除术等：诊断不明确7例,进一步行诊断性刮宫术。结果 335例腹腔镜确诊异位妊娠,333例成功行腹腔镜手术（包括3例卵巢妊娠、3例输卵管间质部妊娠）,2例中转开腹。7例腹腔镜未见明显妊娠部位行诊断性刮宫术,其中1例子宫畸形（残角子宫）合并宫内妊娠行残角子宫及同侧输卵管切除术,1例卵巢黄体囊肿破裂合并宫内妊娠行黄体囊肿剥出术,5例宫内外均未发现妊娠部位,MTX治疗成功。340例腹腔镜术后8～24h肛门排气,除5例MTX保守治疗外,335例术后2～4d出院;2例中转开腹术后24～36h肛门排气,术后6d出院。结论 腹腔镜检查有利于异位妊娠的早期诊断;腹腔镜手术治疗异位妊娠安全有效、恢复快。     

Acute torsion of a wandering spleen in a post-partum female: A case report

INTRODUCTIONWandering spleen is a rare condition characterized by ectopic position of the spleen due to the absence or laxity of peritoneal ligaments that hold the organ within the left upper quadrant. Lower abdomen and pelvis are the most common locations of the wandering spleen. The disorder usually remains asymptomatic.PRESENTATION OF CASEWe present a case of acute abdomen due to torsion of a wandering spleen in a primiparus, healthy female shortly after delivery. Diagnosis was based on ultrasonography and computed tomography and was confirmed later on surgery. Total splenectomy was performed successfully.DISCUSSIONThe rarity of the condition and the nonspecific clinical symptoms and signs make prompt diagnosis challenging.CONCLUSIONPrompt recognition and intervention are necessary in order to minimize the risk of complications. For this reason physicians have to include the condition in the differential diagnosis of acute abdominal pain especially when they encounter females in a pregnancy or post-natal period.     

Ovarian serous cystadenoma with ectopic adrenal tissue in a 65-year-old patient: A case report

IntroductionEctopic adrenal tissue is a very rare entity in adult females, especially in the ovary, and is generally diagnosed incidentally during surgery. Although it can present at various sites during childhood, it becomes atrophic by adulthood due to normally functioning adrenal glands. Patients are predominantly asymptomatic; however, in some cases endocrine symptoms such as hypertension and fasciotruncal obesity due to hormonal activity can be seen or neoplastic transformation can appear.Presentation of caseA 65-year-old patient with progressive pelvic pain and postmenopausal vaginal bleeding was evaluated by transvaginal ultrasound, which revealed bilateral adnexal masses measuring 5 cm in size and a normal uterus with an increased endometrial thickness of 7 mm. Initially the endometrial sampling result was reported as benign. The patient underwent abdominal hysterectomy and bilateral salpingo-oophorectomy and the pathological diagnosis was again benign, with serous ovarian cystadenoma being found in both ovaries. The pathologist also reported incidental ectopic adrenal tissue on the wall of the left ovarian cystadenoma.DiscussionEctopic adrenal tissue is infrequent in female genital organs especially at older ages. Only a few cases of ovarian ectopic adrenal tissue have been reported. To the best of our knowledge the present case is the fourth report in the English literature, and is of additional importance given the patient’s age.ConclusionEctopic adrenal tissues are generally asymptomatic and revealed incidentally during surgery; however some cases have demonstrated the risk of neoplastic transformation. Therefore, surgeons must be aware of this rare entity that bears the risk of malignancy, and should surgically remove all suspicious lesions.